Abstract
BACKGROUND: The coronavirus disease 2019 pandemic impact on sexually transmitted infections in countries practicing syndromic management remains unknown. We conducted cross-sectional surveys in Fiji to assess increases and risk factors for Neisseria gonorrhoeae (NG) and Chlamydia trachomatis (CT) infections pre- and postpandemic. METHODS: We enrolled women, men who have sex only with women (MSW), and men who have sex with men (MSM) aged 18-40 years, collected sociodemographic/behavioral data, and tested vaginal, urethral, and rectal samples using Xpert-CT/NG. Risk factors were evaluated using regression models. RESULTS: Of 1955 participants, 6.4% (95% confidence interval [CI], 5.4%-7.6%) had gonorrhea, increasing significantly postpandemic >2-fold among women aged 25-40 years and >4-fold among MSM, MSW, and men aged 18-24 and 25-40 years; 20.0% (95% CI, 18.3%-21.8%) had chlamydia, increasing significantly postpandemic among younger women and approximately 2- to 4-fold among MSW and younger and older men. Increases were driven by urethral/vaginal infections. Coinfections increased significantly postpandemic among older women. Postpandemic gonorrhea was associated with difficulty obtaining condoms (adjusted relative risk [aRR], 2.7 [95% CI, 1.0-8.0]) and ≥2 partners (aRR, 2.6 [95% CI, 1.0-7.1]) among younger women, and iTaukei ethnicity (aRR, 4.7 [95% CI, 1.4-16.5]) and heavy alcohol use (aRR, 7.1 [95% CI, 2.5-19.7]) among older women. Postpandemic chlamydia was associated with having a casual sex partner among younger (aRR, 1.7 [95% CI, 1.0-2.9]) and older (aRR, 1.9 [95% CI, 1.1-3.4]) women and with being unmarried (aRR, 1.7 [95% CI, 1.0-2.7]). iTaukei men had increased risk postpandemic for gonorrhea (aRR, 3.7 [95% CI, 1.3-10.6]) and chlamydia (aRR, 2.5 [95% CI, 1.3-4.9]). More than 50% of infected participants did not meet syndromic treatment criteria and would have remained untreated. CONCLUSIONS: Postpandemic increases in gonorrhea and chlamydia-with risk factors varying by pathogen, gender, and age-require immediate interventions to reduce infection and transmission in Fiji.